Surgery on Adenoid, Tonsils Improves Outcomes in Children with Obstructive Sleep Apnea

Surgical removal of adenoids and tonsils, or adenotonsillectomy (AT), has been shown to help children with sleep apnea . Children who had these surgeries have experienced improvements in behavior, quality of life, and other symptoms. This is compared to children without these surgeries. Both groups showed no difference in attention and executive functioning.

Sleep apnea is a condition of interrupted breathing cause by a narrowing in the throat or upper airway. This narrowing can be due to enlarged tonsils and adenoids, obesity, or other medical problems. This condition occurs in both adults and children, but is most prevalent in obese patients.

The Childhood Adenotonsillectomy Trial (CHAT) studied 464 children, aged 5 to 9, at seven academic sleep centers. "This was the first randomized clinical trial of surgery for sleep apnea in children," said the study's first author, Carole L. Marcus, M.D., a sleep specialist and director of the Sleep Center at The Children's Hospital of Philadelphia. "Some previous, smaller studies had found this condition associated with cognitive and behavioral problems, including ADHD, so it was important to do a controlled trial to evaluate the benefits of surgery, which is a common treatment."

The study randomized the children to either receive AT or “watchful waiting” treatment with supportive care from 2007 to 2011. Approximately have the children were overweight or obese. All the children underwent a sleep study at an outpatient sleep center. The sleep studies occurred in before treatment and after treatment. Children with severe sleep apnea were not included in this study.

The children were given a Developmental Neuropsychological Assessment to measure attention and executive function. The children’s parents and teachers were also given questionnaires to rate each child’s behavior, sleepiness, quality of life, and executive functioning. They also had to include details of the children’s daily lives including keeping up with tasks, tantrums, and social activity.

The children with surgery experienced more improvements than the children without surgery.

AT is the primary treatment for sleep apnea in children. Over half a million children in the U.S. undergo AT a year.